Chronic diseases: Type 2 Diabetes Mellitus


Assignment extract:

Chronic illness pervades most, if not all areas, of healthcare including emergency, intensive care, and operating theatres. As the population ages, the burden and impact on the healthcare system is shifting from communicable disease to chronic disease, thus affecting health care service providers.
1) Type 2 Diabetes Mellitus
2) Chronic Obstructive Airway Disease
3) Heart Failure (this can include Ischemic Heart Disease.

Give a VERY BRIEF overview of the disease you have selected. Utilizing current literature, identify and investigate the issues relating to the disease of your choice. Think about the following questions to guide your reading and discussion.
*How does the disease impact on: quality of life of the patient, family, and friends?

*What issues are faced in the rural and remote setting? Is this different from urban settings?

*What costs are involved?

*What is the impact on the healthcare system (with regard to presentation to the emergency department, time spent in intensive care, operations such as debridement of diabetic ulcers, etc.)

*What issues are facing population health and health policy? Is there any current policy in place to deal with this disease?

*What are the current management strategies available for this disease? Can you make any recommendations for the current/future management of this disease?
You can identify other questions relating to the disease you select. You can focus your discussion on the most pertinent issues you identify in the literature.

To adequately complete this assignment, you will need to thoroughly utilize the current evidence in the literature. As an absolute minimum, you will need 10 recent journal articles.


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Overview.. 2

Impact of diabetes on patients’ quality of life. 3

Type II Diabetes in rural and remote settings. 4

Cost and impact of Type 2 diabetes mellitus on the healthcare system.. 5

Current health policy and management strategies. 8

Recommendations. 10

References. 10


Type 2 diabetes mellitus is the most commonly occurring form of diabetes. Some groups of people are at a higher risk of developing this disease than others. In this form of diabetes, the pancreas either fails to produce sufficient insulin or body cells ignore the available insulin. Insulin is extremely necessary since it enables the body tissues to convert glucose into energy. When a person eats food, the body breaks it all down, converting starches and sugars and starches into glucose. Glucose is the basic fuel used by all cells in the body for metabolic functions. The role of insulin is to transfer sugar from the blood into different cells. When there is a build-up of sugar in the blood instead of going into the body cells, diabetic complications arise.

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Type 2 diabetes mellitus is more common among the aged population, Native Americans, African Americans, Asian Americans, and Pacific Islanders such as Native Hawaiians. The disease is sometimes controlled using diet, exercise and weight management plans. Treatment for the disease may also include insulin injections and glucose-lowering medications.

Impact of diabetes on patients’ quality of life

Diabetes is a chronic disease with a heavy burden relating to health-related quality of life on the patient. The extent to which the quality of life is affected depends on the degree of severity of the disease. The main aspects of life that are affected include role functioning, emotional well-being, physical functioning, social functioning and cognition. With time, patients’ perceptions of pain and health also change.

Diabetic complications such as nephropathy, retinopathy, neuropathy, stroke, cardiovascular disease, periphery vascular disease, and stroke lead to significantly high morbidity and mortality rates. Self-reported health-related quality of life is the most accurate outcome of assessing the impact of the disease. This is because clinical parameters often fail to give a clear picture of the impact of the disease.

Some commonly used indicators of the advancement of the disease or its severity include the duration of diabetes, treatment intensity, and the number and severity of various complications associated with Type 2 diabetes mellitus. These complications are closely correlated with anxiety, clinical depression and impairment of both disease-specific and generic measures of the patient’s health status. There is sufficient evidence showing that the prolonged duration of diabetes is closely associated with deterioration in the quality of life of a patient. However, some studies have not found out this association (Maddigan, Majumdar, & Toth 2005, p. 97).

The main reason why the burden on quality of life increases with time is that Type 2 diabetes is a chronic, progressive disease whose increase in severity continues to increase a patient’s overall health-related burden. This brings about many physical and mental dimensions of both the health status and quality of life. Treatment with insulin is not only an indicator of the severity of the disease; it is also associated with an increased mental and physical health burden. Other significant influences on quality of life include diet restrictions and increased intensity of treatment. 

Type II Diabetes in rural and remote settings

            In most societies, diabetes patients living in rural and remote areas have a higher burden of this condition compared to those who live with the condition in urban settings. In rural areas, access to healthcare facilities is more limited compared to urban areas. However, conflicting data exist with regard to the quality of care that is offered to Type 2 diabetes mellitus patients living in rural settings (Hicks & Bublitz 2010, p. 1288).

            Hicks & Bublitz (2010, p. 1279) sought to find out the relationship between the quality of healthcare offered to patients in urban versus rural settings in Northeastern Colorado. Hicks and Bublitz assessed decision making and blood pressure (BP) control among Type 2 diabetes mellitus patients.  Questionnaires were filled with information on 26 (13 urban and 13 rural) primary care practices within two research networks that are practice-based. The issues highlighted included BP result, demographic information, type of action taken and reasons given for inaction in cases where no action was taken.  The researchers found out that the quality of care offered for elevated BP was similar in both rural and urban areas.

Cost and impact of Type 2 diabetes mellitus on the healthcare system

Like in other chronic diseases Type 2 diabetes is expensive to treat. There are many medical costs that come with treatment procedures for type 2 diabetes. Additionally, the complications and comorbidities associated with this disease are costly. These costs are a heavy burden not only to patients but also federal and state administrations.

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Brandle Zhou & Smith (2005, p. 2303) studied a random sample of Type 2 diabetes patients in order to determine the direct medical cost of chronic disease. The variables assessed in the study included duration of diabetes, demographic characteristics, diabetes treatments, complications, comorbidities, and glycemic control. Health insurance claims were used to assess costs and annual resource utilization. Diabetes complications and insulin treatment were found to have a substantial effect on the direct medical costs of treating this form of diabetes. The estimates that were presented in this study form an ideal basis for the analysis of the cost-effectiveness of various interventions undertaken for Type 2 diabetes.

            One of the ways in which diabetes patients incur costs is through screening for eye disease (Leahy2008, p. 24). In a study of marginal cost-effectiveness of different screening intervals for Type 2 diabetes patients, Vijan & Hofer (2006, p. 276) found out that annual retinal screening for patients who have not been diagnosed with retinopathy may be unwarranted merely on the basis of cost-effectiveness. Consequently, it may be preferable to tailor recommendations on the basis of individual circumstances. For this reason, Vijan & Hofer (2006, p. 295) suggest that organizations that evaluate the quality of health care ought to pay attention to both costs and costs prior to set universal standards.

            In a study of eight European countries, the total direct medical costs incurred in treating Type 2 diabetes Mellitus totaled EUR 29 billion per year (Jönsson, 2008, p.121). In these countries, each patient, it is estimated, spends EUR 2834 every year. Of these costs, the greatest portion of the money goes to hospitalization. The eight countries in which this research was carried out include France, Belgium, Sweden, Germany, Italy, Spain, the Netherlands, and the United Kingdom. These figures represent an emerging trend whereby the disease is becoming increasingly expensive to control, manage and treat.

During the evaluation period that lasted 6 months, 13 percent of all Type 2 diabetes patients in the eight European countries had been hospitalized. A projection of 23 days’ hospitalization was made for each patient annually. In sharp contrast, the cost of drugs for the management of the disease was rather low. Insulin and anti-diabetic drugs accounted for merely 7 percent of all the annual healthcare costs for the disease (Jönsson 2008, p.121).

The prevalence of Type 2 diabetes mellitus is expected to continue increasing in the future. Consequently, costs associated with the disease will continue to increase, especially in less developed countries (Jönsson, 2008, p.121). There is a need for comprehensive economic data regarding the costs of diabetes as a basis for policy decisions. Such considerations would optimize the allocation of resources as well as facilitate the evaluation of different approaches for managing the disease.

Many researchers use a bottom-up research method, which is prevalence-based. This method is ideal for the collection of data both at the local and national level while at the same time maintaining the standards required for international comparability (Jönsson, 2008, p.122). Consistency is needed for purposes of data collection, specification, sampling, analysis, and reporting. Additionally, the results ought to be reported on the basis of both the individual countries’ totals and the aggregate tally for the entire population being studied (Jönsson 2008, p.121).

            According to Brown (2006, p. 344), few studies have been carried out with an aim of exploring the contextual dimensions and all subsequent interactions contributing to the lack of adherence in the way guidelines for diabetes management are applied. Against this backdrop, Brown carried out a qualitative study with the aim of exploring issues and perceptions of family physicians regarding the facilitators and barriers to the management of various patients suffering from Type 2 diabetes mellitus.

            Brown concluded that in interactions of a physician, patient and systematic factors continue to have implications for the way any diabetes management model is implemented. The care offered to Type 2 diabetes is an exemplification of ongoing challenges relating to the way patients with chronic diseases are taken care of in family practice. Although Brown’s findings are specific to the management of Type 2 Diabetes mellitus, they have a high potential of transferability to many other chronic illnesses that are being managed by family physicians.

In most cases, this type of diabetes is managed by family physicians. The distinct barriers faced in the management of these patients can be categorized into physician factors, patient factors and systemic factors (Brown 2006, p. 346). The important role that education plays is common to each of these factors.

            There is a need for the level of access and utilization of diabetes medical care and outcomes to be assessed on the basis of recent changes in healthcare practices. Such an assessment would be most accurate if, among other things, a representative sample of patients was selected for any given research study.

Harris (2006, p. 756) indicates that the rates of access, utilization, screening for Type 2 diabetic complications, and treatment of hypertension, hyperglycemia and dyslipidemia among Type 2 diabetes remain high. However, notes Harris, the health status, quality of life and outcomes remain unsatisfactory. Some of the reasons for this discordance include patient self-care practices, the intractability of diabetes, characteristics of national healthcare systems, and physician medical care practices (Harris, 2006, p. 756).

Current health policy and management strategies

            One of the most critical issues that arise during the analysis and formulation of healthcare policies relating to chronic diseases such as Type 2 diabetes mellitus is insurance. Coordination of healthcare for patients of chronic diseases is a difficult undertaking without the active participation of all stakeholders, including the government, healthcare providers, employers and healthcare insurance providers.

Traditionally, when indemnity plans were the norm, medical insurance was not a popular term, despite the subsequent separation of healthcare insurance policies into different categories. Today, many Americans still have difficulties figuring out which insurance plan they should take in order to be sure of adequate care in case they develop Type 2 diabetes mellitus in the future. In most cases, patients and members of high-risk populations just give as much medical information as possible and let them figure out in which policy they best fit in.

            However, there are many types of coordination of care that insurance companies appear unprepared to handle. This includes coordination of medications, information, appointments, care regimens prescribed by different members of the medical team. Some policies merely thrust this responsibility squarely on primary healthcare physicians. These physicians are often forced to determine to which extent medical needs extend beyond the limits of one’s professional knowledge. When this happens, they seek the approval of the insurance company before referring the patient to the appropriate specialist. Other insurance companies allow primary care physicians to advise patients to see a particular specialist but to left with the responsibility of setting up appointments.

            Regardless of the particular method that is adopted, Type 2 diabetes mellitus patients need to be guided at the level of federal policy formulation in getting enough information about different specialists. This would enable these patients make informed decisions regarding where they seek medical assistance.

            The current trend in the facilitation of healthcare for diabetes patients in the United States is such that primary care physicians are given copies of the evaluations made by specialists (Vijan & Hofer 2006 p.283). Other information made available to the primary health physician includes the course of the therapy and the outcome.

            The factors that need to be considered in deciding whether there is a need for insulin therapy are diverse and rather complex (Neumiller 2009, p. 87). There is a need for varying viewpoints to be coordinated within a policy framework for ease of reference by physicians. Currently, there are disagreements on whether insulin treatment ought to be considered early among Type 2 diabetes patients or it should be used as a result resort when oral and all other alternative therapies have become ineffective. The burden heavily falls on particular health care terms to weigh carefully many pertinent factors against patient-specific treatment guidelines and goals when coming up with an optimal therapeutic strategy for every patient.

            One of the largest hurdles relating to the initiation of insulin regards overcoming the misconception and fears of patients relating to insulin use (Wanner 2005, p.243). Preconceived patient perceptions on injection pain, regimen complexity and its effect on the quality of life influence hinder objective approaches to the management of the disease. Management approaches also tend to be negatively influenced by patients’ fear of hypoglycemia. Some patients are convinced that the need for insulin is a reflection of personal failure and that they are a failure to both their healthcare providers and their families.


Patient education is of paramount importance in creating awareness on how diabetes should be prevented, controlled, treated and managed. The focus should be on the progressive nature of this disease so that an understanding is created regarding the inevitable course of the disease.

            As more and more patients continue being diagnosed with Type 2 diabetes in the course of their lives, the need for expansion and increased efficiency in health facilities becomes an immediate necessity. Family physicians need to be equipped with the resources that are necessary for them to offer the most efficient healthcare services to patients. Emphasis should be put on formulating policies that are founded on the most successful universal practices. Healthcare authorities should clearly define what constitutes desirable outcomes for all Type 2 diabetes mellitus patients.


Brandle, M, Zhou, H, & Smith, B, 2005, ‘The Direct Medical Cost of Type 2 Diabetes’, Diabetes Care, Vol. 26 No. 8, pp. 2300-2304.

Brown, J, 2006, ‘The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus’ Family Practice, Vol. 19, No. 4, 344-349.

Harris, M, 2006, ‘Health care and health status and outcomes for patients with type 2 diabetes’, Diabetes Care, Vol. 23, No. 6, pp. 754-758

Hicks, P, & Bublitz, C, 2010, ‘Comparison of HTN management in patients with diabetes between rural and urban primary care clinics in Northeastern Colorado – a report from SNOCAP’, Rural and Remote Health, Vol. 10, (3), pp. 1279-1298.

Jönsson, B, 2008, ‘Revealing the cost of Type II diabetes in Europe’ Diabetologia,Vol. 45, No. 7, pp. 112-146.

Leahy, J, 2008, ‘Pathogenesis of Type 2 Diabetes Mellitus’, Type 2 Diabetes Mellitus Contemporary Endocrinology, pp. Vol. 2, No. 3, pp. 17-33.

Maddigan, S, Majumdar, S, & Toth, E, 2005, ‘Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes’, Health and Quality of Life Outcomes, Vol. 1, No. 3, pp. 78-89.

Neumiller, J, 2009, ‘Update on Insulin Management in Type 2 Diabetes’, Diabetes Spectrum, Vol. 22, No. 2, 85-91.

Vijan, S, & Hofer,T, 2006, ‘Cost-Utility Analysis of Screening Intervals for Diabetic Retinopathy in Patients With Type 2 Diabetes Mellitus’, JAMA, Vol. 283, No. 7, 272-295.

Wanner,C, 2005, Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis, The New England Journal of Medicine, Vol. 353, No. 3, pp. 238-248.

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